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From the 6/11/2021 release of VAERS data:

This is VAERS ID 275111

Case Details

VAERS ID: 275111 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Female  
Location: North Carolina  
   Days after vaccination:0
Submitted: 2007-03-28
   Days after onset:14
Entered: 2007-03-29
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Diarrhoea, Haematochezia, Pain, Pyrexia, Renal failure acute
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: hearing loss since age 3, wears hearing aid left ear. Pyelonephritis, renal cysts. Migraine headaches, multiple episodes of allergies, allergic rhinitis, sinusitis, pharyngitis, recurrent ear infections, gastroenteritis, tonsillitis & tonsillar hypertrophy, cellulitis & viral illness. Patient was home schooled & had hx of ADD, taking Adderall. Family HX: patient''s maternal aunt w/renal failure since age 3, had 3 unsuccessful kidney transplants & died.
Diagnostic Lab Data: Unknown LABS 3/18 admit: urine & blood c/s revealed E.coli. Creatinine peak at 9. Renal US revealed echogenic kidneys w/poor corticomedullary differentiation containing multiple tiny cysts; normal renal artery acceleration times w/slightly elevated resistive indices. Repeat urine c/s neg at d/c. LABS 3/27 admit: HD catheter, urine & blood c/s neg. Rotavirus +. Creatinine 4. C. diff neg. LABS 4/25/07: serum creatinine 3.1 & creatinine clearance of 21.9mL/min 4/27/07 - TEE done which was normal & revealed no LVH. 5/7/07 MRI of brain was WNL.
CDC Split Type: WAES0703USA03783

Write-up: Information has been received from a physician concerning a 13 year old female who, on an unspecified date, was vaccinated intramuscularly with a second dose of Gardasil. Within 24-48 hours, the patient experienced fever, achiness and diarrhea. The physician reported that 1-2 days later, the patient developed blood in the stool and was admitted to the hospital. The physician reported that the patient was diagnosed with acute kidney failure and was still hospitalized. At the time of this report, the patient''s fever, achiness and acute kidney failure persisted. Fever, achiness and acute kidney failure were considered to be immediately life-threatening and disabling. Additional information has been requested. 5/18/07 Received medical records from hospital which reveal patient seen at hospital 3/18-3/26/07 for nausea, vomiting, bloody diarrhea & fever starting approx 3/11/07. Found to have asymptomatic E.coli UTI that traveled to kidneys. Treated w/IV antibiotics & started on dialysis & placed on kidney transplant list. Progressed well & d/c to home on oral antibiotics. FINAL DX: acute renal failure, urosepsis, polycystic kidney disease, end stage renal failure, hemodialysis. 3/27-4/2/07 - Re-Admitted to pediatric nephrology with fever, dizziness & orthostasis. Treated w/multiple IV antibiotics. Was to continue dialysis but at least 2 sessions cancelled due to hypotension. Outpatient hemodialysis was arranged closer to her home & was to continue IV antibiotics at dialysis center as well as continue on oral antibiotics. Plan was to transition to peritoneal dialysis after off antibiotics for 1 week. FINAL DX: posible partially treated urosepsis; end stage renal disease; polysystic kidney disease; rotavirus gastroenteritis; h/o acute renal failure. 4/25/07 Seen in Dialysis at outlying center. Doing well, last dose of antibiotics on 4/13 & afebrile since then. Labs were much improved & a trial of decreased dialysis was discussed. 5/4/07 - Seen in surgery clinic for evaluation of peritoneal dialysis catheter for acute renal failure superimposed on chronic renal failure. HD site noted to possibly be infected & was started on oral antibiotics. Repeat stool & urine tests ordered & scheduled for PD placement. 5/7/07 MRI of brain was WNL. 6/22/07 Received medical records & vax record from reporter/provider which reveal patient received HPV on 3/14/07 & was 1st dose. VAERS database updated w/same. Medical records of 1994-2004.

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